Options for pharmacoresistant epilepsy in children: when medications don't work

Medications are often first-line treatment for epilepsy in children. A detailed review of antiepileptic drugs and their application in various epilepsy syndromes is provided in the article "Antiepileptic Drugs--A Review" by Sankaraneni and Lachhwani (this issue). Here, we will focus on nonmedicinal approaches-some fairly longstanding and described since Biblical times such as the ketogenic diet while others are relatively new such as neurostimulation. Yet, others such as cannabinoids have been utilized for centuries for their medicinal properties, but we are just learning the scientific basis behind their efficacy. Families are often interested in nonmedicinal avenues of treatment, and knowledge of these options can empower a pediatrician to help families make choices that have scientific validity.